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General NPI Number Information
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NPI Number | 1770005381
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Entity Type | Individual
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Provider Name | ELKA MARIE CHAMBERLAIN CPSS, LLMSW
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Gender | Female
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Dates
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Enumeration Date | 07/14/2017
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Last Update Date | 07/14/2017
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Provider Practice Location Address
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Address Line | 175 N GROESBECK HWY
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-1562
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Country | US
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Telephone | 586-754-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 491 ONYX CIR
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City | WHITMORE LAKE
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State | MI
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Zip | 48189-8278
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Country | US
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Telephone | 810-844-6068
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801101538
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License Number State | MI
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